Computational Methods for Segmentation of Multi-Modal Multi-Dimensional Cardiac Images

Segmentation of the heart structures helps compute the cardiac contractile function quantified via the systolic and diastolic volumes, ejection fraction, and myocardial mass, representing a reliable diagnostic value. Similarly, quantification of the myocardial mechanics throughout the cardiac cycle, analysis of the activation patterns in the heart via electrocardiography (ECG) signals, serve as good cardiac diagnosis indicators. Furthermore, high quality anatomical models of the heart can be used in planning and guidance of minimally invasive interventions under the assistance of image guidance. The most crucial step for the above mentioned applications is to segment the ventricles and myocardium from the acquired cardiac image data. Although the manual delineation of the heart structures is deemed as the gold-standard approach, it requires significant time and effort, and is highly susceptible to inter- and intra-observer variability. These limitations suggest a need for fast, robust, and accurate semi- or fully-automatic segmentation algorithms. However, the complex motion and anatomy of the heart, indistinct borders due to blood flow, the presence of trabeculations, intensity inhomogeneity, and various other imaging artifacts, makes the segmentation task challenging. In this work, we present and evaluate segmentation algorithms for multi-modal, multi-dimensional cardiac image datasets. Firstly, we segment the left ventricle (LV) blood-pool from a tri-plane 2D+time trans-esophageal (TEE) ultrasound acquisition using local phase based filtering and graph-cut technique, propagate the segmentation throughout the cardiac cycle using non-rigid registration-based motion extraction, and reconstruct the 3D LV geometry. Secondly, we segment the LV blood-pool and myocardium from an open-source 4D cardiac cine Magnetic Resonance Imaging (MRI) dataset by incorporating average atlas based shape constraint into the graph-cut framework and iterative segmentation refinement. The developed fast and robust framework is further extended to perform right ventricle (RV) blood-pool segmentation from a different open-source 4D cardiac cine MRI dataset. Next, we employ convolutional neural network based multi-task learning framework to segment the myocardium and regress its area, simultaneously, and show that segmentation based computation of the myocardial area is significantly better than that regressed directly from the network, while also being more interpretable. Finally, we impose a weak shape constraint via multi-task learning framework in a fully convolutional network and show improved segmentation performance for LV, RV and myocardium across healthy and pathological cases, as well as, in the challenging apical and basal slices in two open-source 4D cardiac cine MRI datasets. We demonstrate the accuracy and robustness of the proposed segmentation methods by comparing the obtained results against the provided gold-standard manual segmentations, as well as with other competing segmentation methods

Segmentación rápida del ventrículo derecho en cine-MRI a partir de una representación densa de Hough

Segmentation of the right ventricle (RV) is essential for the diagnosis of multiple cardiac pathologies and conditions. However, its manual delineation is a tedious task and computational support is complex due to geometric and dynamic variability.  This work introduces a dense Hough transform and representation (HT) that allows a nonparametric characterization of the shape, encoding each voxel by its curvature and orientation. This representation is integrated into a bayesian tracking approach, which efficiently segments the RV structure throughout the cardiac cycle. The proposed approach was evaluated on a public dataset, with 16 patients, achieving a Sørensen-Dice coefficient of 0.87 and 0.92, for complete volumes and basal structures, respectively. These results evidence an adequate fit of the proposed model with respect to RV shape throughout the entire cardiac cycle. La segmentación del Ventrículo Derecho (VD) es esencial para el diagnóstico de múltiples patologías y condiciones cardiacas. Sin embargo, su delineación manual es una tarea tediosa y el soporte computacional resulta complejo debido a la variabilidad geométrica y dinámica.  Este trabajo introduce una transformación y representación densa de Hough (TH) que permite una caracterización no paramétrica de la forma, codificando cada vóxel por su curvatura y orientación. Esta representación es integrada en un enfoque de seguimiento bayesiano, que logra de forma eficiente segmentar la estructura del VD, a lo largo del ciclo cardíaco. El enfoque propuesto fue evaluado en un conjunto de datos públicos, con 16 pacientes, logrando un coeficiente Sørensen-Dice de 0,87 y 0,92, para volúmenes completos y estructuras basales, respectivamente. Estos resultados evidencian una adecuada adaptación del modelo propuesto respecto a la forma del VD a lo largo de todo el ciclo cardíaco.La segmentación del Ventrículo Derecho (VD) es esencial para el diagnóstico de múltiples patologías y condiciones cardiacas. Sin embargo, su delineación manual es una tarea tediosa y el soporte computacional resulta complejo debido a la variabilidad geométrica y dinámica.  Este trabajo introduce una transformación y representación densa de Hough (TH) que permite una caracterización no paramétrica de la forma, codificando cada vóxel por su curvatura y orientación. Esta representación es integrada en un enfoque de seguimiento bayesiano, que logra de forma eficiente segmentar la estructura del VD, a lo largo del ciclo cardíaco. El enfoque propuesto fue evaluado en un conjunto de datos públicos, con 16 pacientes, logrando un coeficiente Sørensen-Dice de 0,87 y 0,92, para volúmenes completos y estructuras basales, respectivamente. Estos resultados evidencian una adecuada adaptación del modelo propuesto respecto a la forma del VD a lo largo de todo el ciclo cardíaco

Automatic Assessment of Cardiac Left Ventricular Function Via Magnetic Resonance Images

Automating global and segmental (regional) assessments of cardiac Left Ventricle (LV) function in Magnetic Resonance Images (MRI) has recently sparked an impressive research effort, which has resulted a number of techniques delivering promising performances. However, despite such an effort, the problem is still acknowledged to be challenging, with substantial room for improvements in regard to accuracy. Furthermore, most of the existing techniques are labour intensive, requiring delineations of the endo- and/or epi-cardial boundaries in all frames of a cardiac sequence. On the one hand, global assessments of LV function focus on estimation of the Ejection Fraction (EF), which quantifies how much blood the heart is pumping within each beat. On the other hand, regional assessments focus on comprehensive analysis of the wall motions within each of the standardized segments of the myocardium, the muscle which contracts and sends the blood out of the LV. In clinical practice, the EF is often estimated via manual segmentations of several images in a cardiac sequence. This is prohibitively time consuming, or via automatic segmentations, which is a challenging and computationally expensive task that may result in high estimation errors. Additionally, the diagnosis of the segmental dysfunction is based on visual LV assessments, which are subject to high inter-observer variability. In this thesis, we propose accurate methods to estimate both global and regional LV function with minimal user inputs in real-time from statistics estimated in MRI. From a simple user input, we build image statistics for all the images in a subject dataset. We demonstrate that these statistics are correlated with regional as well as global LV function. Different machine learning techniques have been employed to find these correlations. The regional dysfunction is investigated in terms of a binary/multi-classification problem. A comprehensive evaluation over 20 subjects demonstrated that the estimated EFs correlated very well with those obtained from independent manual segmentations. Furthermore, comparisons with estimating EF with recent segmentation algorithms show that the proposed method yielded a very competitive performance. For regional binary classification, we report a comprehensive experimental evaluation of the proposed algorithm over 928 cardiac segments obtained from 58 subjects. Compared against ground-truth evaluations by experienced radiologists, the proposed algorithm performed competitively, with an overall classification accuracy of 86.09% and a kappa measure of 0.73. We also report a comprehensive experimental evaluation of the proposed multi-classification algorithm over the same dataset. Compared against ground-truth labels assessed by experienced radiologists, the proposed algorithm yielded an overall 4-class accuracy of 74.14%

Developing advanced mathematical models for detecting abnormalities in 2D/3D medical structures.

Detecting abnormalities in two-dimensional (2D) and three-dimensional (3D) medical structures is among the most interesting and challenging research areas in the medical imaging field. Obtaining the desired accurate automated quantification of abnormalities in medical structures is still very challenging. This is due to a large and constantly growing number of different objects of interest and associated abnormalities, large variations of their appearances and shapes in images, different medical imaging modalities, and associated changes of signal homogeneity and noise for each object. The main objective of this dissertation is to address these problems and to provide proper mathematical models and techniques that are capable of analyzing low and high resolution medical data and providing an accurate, automated analysis of the abnormalities in medical structures in terms of their area/volume, shape, and associated abnormal functionality. This dissertation presents different preliminary mathematical models and techniques that are applied in three case studies: (i) detecting abnormal tissue in the left ventricle (LV) wall of the heart from delayed contrast-enhanced cardiac magnetic resonance images (MRI), (ii) detecting local cardiac diseases based on estimating the functional strain metric from cardiac cine MRI, and (iii) identifying the abnormalities in the corpus callosum (CC) brain structure—the largest fiber bundle that connects the two hemispheres in the brain—for subjects that suffer from developmental brain disorders. For detecting the abnormal tissue in the heart, a graph-cut mathematical optimization model with a cost function that accounts for the object’s visual appearance and shape is used to segment the the inner cavity. The model is further integrated with a geometric model (i.e., a fast marching level set model) to segment the outer border of the myocardial wall (the LV). Then the abnormal tissue in the myocardium wall (also called dead tissue, pathological tissue, or infarct area) is identified based on a joint Markov-Gibbs random field (MGRF) model of the image and its region (segmentation) map that accounts for the pixel intensities and the spatial interactions between the pixels. Experiments with real in-vivo data and comparative results with ground truth (identified by a radiologist) and other approaches showed that the proposed framework can accurately detect the pathological tissue and can provide useful metrics for radiologists and clinicians. To estimate the strain from cardiac cine MRI, a novel method based on tracking the LV wall geometry is proposed. To achieve this goal, a partial differential equation (PDE) method is applied to track the LV wall points by solving the Laplace equation between the LV contours of each two successive image frames over the cardiac cycle. The main advantage of the proposed tracking method over traditional texture-based methods is its ability to track the movement and rotation of the LV wall based on tracking the geometric features of the inner, mid-, and outer walls of the LV. This overcomes noise sources that come from scanner and heart motion. To identify the abnormalities in the CC from brain MRI, the CCs are aligned using a rigid registration model and are segmented using a shape-appearance model. Then, they are mapped to a simple unified space for analysis. This work introduces a novel cylindrical mapping model, which is conformal (i.e., one to one transformation and bijective), that enables accurate 3D shape analysis of the CC in the cylindrical domain. The framework can detect abnormalities in all divisions of the CC (i.e., splenium, rostrum, genu and body). In addition, it offers a whole 3D analysis of the CC abnormalities instead of only area-based analysis as done by previous groups. The initial classification results based on the centerline length and CC thickness suggest that the proposed CC shape analysis is a promising supplement to the current techniques for diagnosing dyslexia. The proposed techniques in this dissertation have been successfully tested on complex synthetic and MR images and can be used to advantage in many of today’s clinical applications of computer-assisted medical diagnostics and intervention

Cardiac Image Segmentation from Cine Cardiac MRI Using Graph Cuts and Shape Priors

In this paper, we propose a novel method for segmentation of the left ventricle, right ventricle, and myocardium from cine cardiac magnetic resonance images of the STACOM database. Our method incorporates prior shape information in a graph cut framework to achieve segmentation. Poor edge information and large within-patient shape variation of the different parts necessitates the inclusion of prior shape information. But large interpatient shape variability makes it difficult to have a generalized shape model. Therefore, for every dataset the shape prior is chosen as a single image clearly showing the different parts. Prior shape information is obtained from a combination of distance functions and orientation angle histograms of each pixel relative to the prior shape. To account for shape changes, pixels near the boundary are allowed to change their labels by appropriate formulation of the penalty and smoothness costs. Our method consists of two stages. In the first stage, segmentation is performed using only intensity information which is the starting point for the second stage combining intensity and shape information to get the final segmentation. Experimental results on different subsets of 30 real patient datasets show higher segmentation accuracy in using shape information and our method's superior performance over other competing method

Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table

Deep Learning Techniques for Automatic MRI Cardiac Multi-Structures Segmentation and Diagnosis: Is the Problem Solved?

Delineation of the left ventricular cavity, myocardium, and right ventricle from cardiac magnetic resonance images (multi-slice 2-D cine MRI) is a common clinical task to establish diagnosis. The automation of the corresponding tasks has thus been the subject of intense research over the past decades. In this paper, we introduce the "Automatic Cardiac Diagnosis Challenge" dataset (ACDC), the largest publicly available and fully annotated dataset for the purpose of cardiac MRI (CMR) assessment. The dataset contains data from 150 multi-equipments CMRI recordings with reference measurements and classification from two medical experts. The overarching objective of this paper is to measure how far state-of-the-art deep learning methods can go at assessing CMRI, i.e., segmenting the myocardium and the two ventricles as well as classifying pathologies. In the wake of the 2017 MICCAI-ACDC challenge, we report results from deep learning methods provided by nine research groups for the segmentation task and four groups for the classification task. Results show that the best methods faithfully reproduce the expert analysis, leading to a mean value of 0.97 correlation score for the automatic extraction of clinical indices and an accuracy of 0.96 for automatic diagnosis. These results clearly open the door to highly accurate and fully automatic analysis of cardiac CMRI. We also identify scenarios for which deep learning methods are still failing. Both the dataset and detailed results are publicly available online, while the platform will remain open for new submissions

Cardiac MRI Segmentation Using Mutual Context Information from Left and Right Ventricle

In this paper, we propose a graphcut method to segment the cardiac right ventricle (RV) and left ventricle (LV) by using context information from each other. Contextual information is very helpful in medical image segmentation because the relative arrangement of different organs is the same. In addition to the conventional log-likelihood penalty, we also include a "context penalty” that captures the geometric relationship between the RV and LV. Contextual information for the RV is obtained by learning its geometrical relationship with respect to the LV. Similarly, RV provides geometrical context information for LV segmentation. The smoothness cost is formulated as a function of the learned context which helps in accurate labeling of pixels. Experimental results on real patient datasets from the STACOM database show the efficacy of our method in accurately segmenting the LV and RV. We also conduct experiments on simulated datasets to investigate our method's robustness to noise and inaccurate segmentation

Automatic Cardiac Segmentation Using Semantic Information from Random Forests

We propose a fully automated method for segmenting the cardiac right ventricle (RV) from magnetic resonance (MR) images. Given a MR test image, it is first oversegmented into superpixels and each superpixel is analyzed to detect the presence of RV regions using random forest (RF) classifiers. The superpixels containing RV regions constitute the region of interest (ROI) which is used to segment the actual RV. Probability maps are generated for each ROI pixel using a second set of RF classifiers which give the probabilities of each pixel belonging to RV or background. The negative log-likelihood of these maps are used as penalty costs in a graph cut segmentation framework. Low-level features like intensity statistics, texture anisotropy and curvature asymmetry, and high level context features are used at different stages. Smoothness constraints are imposed based on semantic information (importance of each feature to the classification task) derived from the second set of learned RF classifiers. Experimental results show that compared to conventional method our algorithm achieves superior performance due to the inclusion of semantic knowledge and context information